Healthcare Provider Details

I. General information

NPI: 1003449349
Provider Name (Legal Business Name): AMANDA SCOTT MESHAW BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2020
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 S WHITE ST # 150
WAKE FOREST NC
27587-2773
US

IV. Provider business mailing address

104 S WHITE ST # 150
WAKE FOREST NC
27587-2773
US

V. Phone/Fax

Practice location:
  • Phone: 919-891-1530
  • Fax:
Mailing address:
  • Phone: 919-891-1530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-67869
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1730
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: